Question of the Day

Whose side of the story do you believe?

U.S. officials Thursday more than tripled their estimate of the number of flu deaths over the past several months, saying their previous counting method understated the number of fatalities from the novel H1N1 virus.

New estimates by the U.S. Centers for Disease Control and Prevention gave a mid-range estimate of 3,900 Americans dying from the virus between April and mid-October. The previous count had listed only 1,200 flu deaths in the six-month reporting period.

The increase in deaths among children under age 18 was particularly large - more than quadrupling from 129 under the old method of counting to 540 under the new.

Dr. Anne Schuchat said the CDC was using “a new estimate system” that she said provided “a bigger, better picture” of the pandemic’s spread.

The CDC’s new method is not a count, but rather a statistical estimate based on surveys of laboratory-confirmed influenza-related hospitalizations in 62 counties covering 13 metropolitan areas of 10 states - then extrapolated to the entire country. Other data come from aggregate state reporting of laboratory-confirmed hospitalizations and deaths.

The old method relied almost exclusively on counting actual laboratory-confirmed H1N1 hospitalizations and deaths, which CDC has long maintained would understate the epidemic because of inaccurate results, the fact that many flu deaths are undiagnosed or attributed to other causes, or occur outside hospitals.

However, the CDC warned on its Web site that because the new figure is an estimate, “it may never be possible to validate the accuracy of these figures.”

In addition to the 540 child deaths in the six-month period, the flu killed 2,920 adults age 18 to 64; and 440 adults 65 and older. An estimated 22 million Americans, including 8 million children, have been infected by the new flu strain, resulting in 98,000 hospitalizations, 36,000 of which were from people under age 18.

Dr. Schuchat also predicted that H1N1 would wind up taking more children’s lives than seasonal flu, which usually has a harder effect on the elderly but which has not seen its season kick in yet. With H1N1, the reverse pattern seems to be the case.

“I do believe the pediatric death toll will be greater than with seasonal flu,” she said.

Noting that November is American Diabetes Month, Dr. Schuchat also introduced recommendations to doctors for handling flu cases among diabetes patients.

People with the disease account for 12 percent of all flu hospitalizations to date, with one in four of those diabetics being admitted to the intensive care unit.

“People with diabetes have an increased risk of severe illness from any flu, and when people with diabetes get flu, it can be more difficult for them to manage their blood sugar,” she said.

To improve matters, she recommended that people with diabetes are a priority group who should get the H1N1 vaccine by injection, “not the nasal spray.” Those who have symptoms of respiratory illness should also get the viral medicine Tamiflu and not wait for test results confirming a flu illness. A third step, she said, was to “make sure they have been vaccinated against” pneumonia and related infections.

CDC has maintained throughout the new flu pandemic that relatively low numbers of the elderly are stricken fatally - compared with the 90 percent figure of deaths in this age group from regular seasonal flu.

Dr. Schuchat referred to H1N1 as “disproportionately affecting children and young adults,” but a new study published online this week in the British medical journal the Lancet paints a slightly different picture of the first cases of H1N1 in Mexico in April.

For a number of reasons, infants and young people 10 to 19 were the most likely to be infected, “but disease was more severe in infants and those older than 60 years than in other age groups,” the report stated. And the greatest risk of death was to people 70 years and older.